Sinusitis

Sinusitis refers to inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection.

Causes

The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes) that are lined with mucus membranes. Healthy sinuses contain no bacteria or other germs. Usually, mucus is able to drain out and air is able to circulate.

When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.

Sinusitis can occur from one of these conditions:

Small hairs (cilia) in the sinuses, which help move mucus out, do not work properly due to some medical conditions.

Colds and allergies may cause too mucuh mucus to be made or block the opening of the sinuses.

A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

Sinusitis can be:

Acute – symptoms last 2 – 8 weeks

Chronic – symptoms last much longer

Acute sinusitis is caused by damage to the lining of the sinuses from surgery or infections. Chronic sinusitis may be caused by bacteria or a fungus.

The following may increase your risk or your child’s risk of developing sinusitis:

Allergic rhinitis or hay fever

Cystic fibrosis

Day care

Diseases that prevent the cilia from working properly, such as Kartagener syndrome and immotile cilia syndrome.

Changes in altitude (flying or scuba diving)

Large adenoids

Tooth infections (rare)

Weakened immune system from HIV or chemotherapy

Symptoms

The classic symptoms of acute sinusitis in adults usually follow a cold that does not improve, or one that worsens after 5 – 7 days of symptoms. Symptoms include:

Bad breath or loss of smell

Cough, often worse at night

Fatigue and generally not feeling well

Fever

Headache – pressure-like pain, pain behind the eyes, toothache, or facial tenderness

Nasal congestion and discharge

Sore throat and postnasal drip

Symptoms of chronic sinusitis are the same as those of acute sinusitis, but tend to be milder and last longer than 8 weeks.

Symptoms of sinusitis in children include:

Cold or respiratory illness that has been improving and then begins to get worse.

High fever, along with a darkened nasal discharge, for at least 3 days Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving.

Exams and Tests

The doctor will examine you or your child for sinusitis by:

Looking in the nose for signs of polyps

Shining a light against the sinus (transillumination) for signs of inflammation

Tapping over a sinus area to find infection

Regular x-rays of the sinuses are not very accurate for diagnosing sinusitis.

Viewing the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) may help diagnose sinusitis. This is usually done by doctor who specializes in ear, nose, and throat problems (ENT).

However, these tests are not very sensitive at detecting sinusitis, and are often considered unnecessary.

A CT scan of the sinuses may also be used to help diagnose sinusitis. If sinusitis is thought to involve a tumor or fungal infection, an MRI of the sinuses may be necessary.

If you or your child has chronic or recurrent sinusitis, other tests may include:

Allergy testing

Blood tests for HIV or other tests for poor immune function

Ciliary function tests

Nasal cytology

Sweat chloride tests for cystic fibrosis

Treatment

Try the following measures to help reduce congestion in your sinuses:

Apply a warm, moist washcloth to your face several times a day.

Drink plenty of fluids to thin the mucus.

Inhale steam 2 – 4 times per day (for example, sitting in the bathroom with the shower running).

Spray with nasal saline several times per day.

Use a humidifier.

Be careful with over-the-counter spray nasal decongestants. They may help at first, but using them beyond 3 – 5 days can actually worsen nasal congestion.

Also, for sinus pain or pressure:

Avoid flying when you are congested.

Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.

Try acetaminophen or ibuprofen.

Antibiotics are usually not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time you or your child is sick. Antibiotics may be prescribed sooner for:

Children with nasal discharge, possibly with a cough, that is not getting better after 2 – 3 weeks

Fever higher than 102.2° Fahrenheit (39° Celsius)

Severe swelling around the eyes

Headache or pain in the face

At some point, your doctor will consider prescription medications, antibiotics, further testing, or referral to an ear, nose, and throat (ENT) or allergy specialist.

Other treatments for sinusitis include:

Allergy shots (immunotherapy) to help prevent the disease from returning

Avoiding allergy triggers

Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are swollen structures (such as nasal polyps) or allergies

Acute sinusitis should be treated for 10 – 14 days. Chronic sinusitis should be treated for 3 – 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

Surgery to clean and drain the sinuses may also be necessary, especially in patients whose inflammation returns, despite medical treatment. An ENT specialist (also known as an otolaryngologist) can perform this surgery.

Most fungal sinus infections require surgery. Surgical repair of a deviated septum or nasal polyps may prevent the condition from returning.